Long-Term Management of Sleep Apnea-Hypopnea Syndrome: Efficacy and Challenges of Continuous Positive Airway Pressure Therapy-A Narrative Review

Abstract

Sleep apnea-hypopnea syndrome (SAHS) is a respiratory disorder characterized by cessation of breathing during sleep, resulting in daytime somnolence and various comorbidities. SAHS encompasses obstructive sleep apnea (OSA), caused by upper airway obstruction, and central sleep apnea (CSA), resulting from lack of brainstem signaling for respiration. Continuous positive airway pressure (CPAP) therapy is the gold standard treatment for SAHS, reducing apnea and hypopnea episodes by providing continuous airflow. CPAP enhances sleep quality and improves overall health by reducing the risk of comorbidities such as hypertension, type 2 diabetes mellitus, cardiovascular disease and stroke. CPAP nonadherence leads to health deterioration and occurs due to mask discomfort, unsupportive partners, upper respiratory dryness, and claustrophobia. Technological advancements such as auto-titrating positive airway pressure (APAP) systems, smart fit mask interface systems, and telemonitoring devices offer patients greater comfort and enhance adherence. Future research should focus on new technological developments, such as artificial intelligence, which may detect treatment failure and alert providers to intervene accordingly.

Keywords: CPAP adherence; CPAP noncompliance; adaptive servo ventilation; apnea hypopnea index; bilevel positive airway pressure; central sleep apnea; continuous positive airway pressure; obstructive sleep apnea; risk factors for obstructive sleep apnea; sleep apnea hypopnea syndrome.

Figure 1

CPAP therapy alternatives and adjuvants for patients with SAHS. Abbreviations: SAHS—sleep apnea hypopnea syndrome, CPAP—continuous positive airway pressure, BiPaP—bilevel positive airway pressure, ASV—adaptive servo-ventilation, PNS—phrenic nerve stimulation. Figure created with BioRender. All credits to Aakash Mahato.